Elevate Your Emergency Nursing Practice

Bret P. Nelson, MD, RDMS, FACEP

Bret Nelson is a Professor of Emergency Medicine, Chief of the Emergency Medicine Ultrasound Division at the Icahn School of Medicine at Mount Sinai, Chief Editor of the ultrasound education website, www.SinaiEM.us. He is on the board of directors of the Society for Clinical Ultrasound Fellowships and active in the American College of Emergency Physicians (ACEP)’s Ultrasound Section and is among the authors of ACEP’s Emergency Ultrasound Guidelines. Served on the Board of Directors of the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and was Chair of the American Institute of Ultrasound in Medicine’s Point of Care Community of Practice

Dr. Nelson has lectured throughout the world on the use of point-of-care ultrasound to aid medical decision-making and improve patient safety. His research interests include ultrasound and medical education.

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We created a culture where once a nurse finishes competency, they are able to place ultrasound-guided IV access on their own. Sometimes, you run into trouble and usually it’s because the patient has limited veins, so they are still able to ask for help. Have another person look with the ultrasound. It’s okay to ask for help!

This has also increased more collegial respect between disciplines and increased teamwork.

Nurse buy-in and Physician buy-in

We decided to make this program optional for nurses.

Currently we only have this program for our adult population in the ED.

Nurses love the program and so do our patients!

Support from Nursing and Physician Leadership

Talk to your Nursing and Physician Directors of your department.

Keep them in the loop.

I have found Leadership to be extremely supportive and helpful.

Nursing Policy and Nursing Education

Written policy for nurses is important to have in writing within your department/institution.

Work with your Nursing Director and/or Nursing Education in order to develop policy if it’s not already written or change/expand existing policy.

Know your policy. Some may restrict this skill to nurses working in specific departments.

Took us awhile to get the green light and policy.

Nursing Education requires nurses to have a training program and competency before performing skill on their own.

Lots of admin stuff but worth it.

*Docs reading this – There’s no workaround, you must do this.

Our training program requires the following:

Didactic portion

Hands-on training portion with using gel models and ultrasound machines

Competency

*Our competency requires nurses to have 10 supervised insertions and an OSCE checklist for the first one.

You may find you will need less or more supervised insertions.

Desire for Program/Currently No Program

Send nurses from your shop to an established course to obtain skill

Beneficial to brush up on existing skills

Beneficial to experience a different course and apply teaching methods in own shop

Take the initiative and work with a provider who has ultrasound training

Program Improvement

See what works for your shop and modify the training program to suit your needs